Healthcare Payer Services Market by Outsourcing Service Type (Business Process Outsourcing (BPO), Information Technology Outsourcing (ITO), Knowledge Process Outsourcing (KPO)), Application (Analytics & Fraud Management, Billing & Accounts Management, Claims Management), End User - Global Forecast 2023-2030
The Healthcare Payer Services Market size was estimated at USD 64.79 billion in 2022 and expected to reach USD 70.18 billion in 2023, at a CAGR 8.95% to reach USD 128.63 billion by 2030.
Market Segmentation & Coverage:
This research report analyzes various sub-markets, forecasts revenues, and examines emerging trends in each category to provide a comprehensive outlook on the Healthcare Payer Services Market.
- Based on Outsourcing Service Type, market is studied across Business Process Outsourcing (BPO), Information Technology Outsourcing (ITO), and Knowledge Process Outsourcing (KPO). The Information Technology Outsourcing (ITO) commanded largest market share of 39.67% in 2022, followed by Business Process Outsourcing (BPO).
- Based on Application, market is studied across Analytics & Fraud Management, Billing & Accounts Management, Claims Management, HR Services Management, Integrated Front Office Service & Back Office Operations Member Management, and Provider Network Management. The Claims Management commanded largest market share of 30.21% in 2022, followed by Billing & Accounts Management.
- Based on End User, market is studied across Private Payers and Public Payers. The Private Payers commanded largest market share of 65.77% in 2022, followed by Public Payers.
- Based on Region, market is studied across Americas, Asia-Pacific, and Europe, Middle East & Africa. The Americas is further studied across Argentina, Brazil, Canada, Mexico, and United States. The United States is further studied across California, Florida, Illinois, New York, Ohio, Pennsylvania, and Texas. The Asia-Pacific is further studied across Australia, China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. The Europe, Middle East & Africa is further studied across Denmark, Egypt, Finland, France, Germany, Israel, Italy, Netherlands, Nigeria, Norway, Poland, Qatar, Russia, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, and United Kingdom. The Europe, Middle East & Africa commanded largest market share of 38.17% in 2022, followed by Americas.
The report provides market sizing and forecasts across 7 major currencies - USD, EUR, JPY, GBP, AUD, CAD, and CHF; multiple currency support helps organization leaders to make well-informed decisions. In this report, 2018 to 2021 are considered as historical years, 2022 is base year, 2023 is estimated year, and years from 2024 to 2030 are considered as forecast period.
FPNV Positioning Matrix:
The FPNV Positioning Matrix is an indispensable tool for assessing the Healthcare Payer Services Market. It comprehensively evaluates vendors, analyzing key metrics related to Business Strategy and Product Satisfaction. This enables users to make informed decisions tailored to their specific needs. Through advanced analysis, vendors are categorized into four distinct quadrants, each representing a different level of success: Forefront (F), Pathfinder (P), Niche (N), or Vital (V). Be assured that this insightful framework empowers decision-makers to navigate the market with confidence.
Market Share Analysis:
The Market Share Analysis offers invaluable insights into the vendor landscape Healthcare Payer Services Market. By evaluating their impact on overall revenue, customer base, and other key metrics, we provide companies with a comprehensive understanding of their performance and the competitive environment they confront. This analysis also uncovers the level of competition in terms of market share acquisition, fragmentation, dominance, and industry consolidation during the study period.
Key Company Profiles:
The report delves into recent significant developments in the Healthcare Payer Services Market, highlighting leading vendors and their innovative profiles. These include AArete LLC, Accenture PLC, Acurus Solutions, Inc., Anthem Insurance Companies, Inc., athenahealth, Inc., Atos SE, CitiusTech Inc., Clarus RCM, Cognizant Technology Solutions, Concentrix Corporation, Conduent, Inc., Connvertex Technologies Inc., Dell, Inc., ExlService Holdings, Inc., Firstsource Solutions Limited, Genpact Limited, HCL Technologies Limited, Hewlett Packard Enterprise Company, Hexaware Technologies Limited, Hinduja Global Solutions Limited, Infosys Limited, International Business Machines Corporation, Invensis Technologies Pvt. Ltd., IQVIA Inc., Kiriworks, Inc., McKinsey & Company, Mobisoft Infotech LLC, Mphasis, Newgen Software Technologies Limited, Nous Infosystems Pvt. Ltd., NTT DATA Corporation, OSP, Pegasystems Inc., PricewaterhouseCoopers LLP, Protiviti Inc., R1 RCM Inc., Ricoh USA, Inc., ServiceNow, Inc., System Soft Technologies LLC, TATA Consultancy Services Limited, Tech Mahindra Limited, Tegria Holdings LLC, Unimrkt Healthcare LLP, Unitedhealth Group, Vee Technologies, Viaante Business Solutions, VMware, Inc., Wipro Limited, WNS (Holdings) Ltd., and Xerox Corporation.
The report offers valuable insights on the following aspects:
- Market Penetration: It provides comprehensive information about key players' market dynamics and offerings.
- Market Development: In-depth analysis of emerging markets and penetration across mature market segments, highlighting lucrative opportunities.
- Market Diversification: Detailed information about new product launches, untapped geographies, recent developments, and investments.
- Competitive Assessment & Intelligence: Exhaustive assessment of market shares, strategies, products, certifications, regulatory approvals, patent landscape, and manufacturing capabilities of leading players.
- Product Development & Innovation: Intelligent insights on future technologies, R&D activities, and breakthrough product developments.
- What is the market size and forecast for the Healthcare Payer Services Market?
- Which products, segments, applications, and areas hold the highest investment potential in the Healthcare Payer Services Market?
- What is the competitive strategic window for identifying opportunities in the Healthcare Payer Services Market?
- What are the latest technology trends and regulatory frameworks in the Healthcare Payer Services Market?
- What is the market share of the leading vendors in the Healthcare Payer Services Market?
- Which modes and strategic moves are suitable for entering the Healthcare Payer Services Market?
Note: PDF & Excel + Online Access - 1 Year
- 1. Preface
- 1.1. Objectives of the Study
- 1.2. Market Segmentation & Coverage
- 1.3. Years Considered for the Study
- 1.4. Currency & Pricing
- 1.5. Language
- 1.6. Limitations
- 1.7. Assumptions
- 1.8. Stakeholders
- 2. Research Methodology
- 2.1. Define: Research Objective
- 2.2. Determine: Research Design
- 2.3. Prepare: Research Instrument
- 2.4. Collect: Data Source
- 2.5. Analyze: Data Interpretation
- 2.6. Formulate: Data Verification
- 2.7. Publish: Research Report
- 2.8. Repeat: Report Update
- 3. Executive Summary
- 4. Market Overview
- 4.1. Introduction
- 4.2. Healthcare Payer Services Market, by Region
- 5. Market Insights
- 5.1. Market Dynamics
- 5.1.1. Drivers
- 5.1.1.1. Rapid increase in the number of enrollments opting for health insurance
- 5.1.1.2. Increase in the outsourcing supportive insurance services by healthcare payers
- 5.1.1.3. Rising government initiatives to launch health insurance programs
- 5.1.2. Restraints
- 5.1.2.1. Hidden costs associated with outsourcing healthcare payer services
- 5.1.3. Opportunities
- 5.1.3.1. Growing implementation of digital technologies in payer operations
- 5.1.3.2. Incorporation of artificial intelligence (AI), analytics, and cloud-based service in healthcare insurance portfolio
- 5.1.4. Challenges
- 5.1.4.1. Risks of cyber theft and data breach
- 5.2. Market Segmentation Analysis
- 5.3. Market Trend Analysis
- 5.4. Cumulative Impact of COVID-19
- 5.5. Cumulative Impact of Russia-Ukraine Conflict
- 5.6. Cumulative Impact of High Inflation
- 5.7. Porter’s Five Forces Analysis
- 5.7.1. Threat of New Entrants
- 5.7.2. Threat of Substitutes
- 5.7.3. Bargaining Power of Customers
- 5.7.4. Bargaining Power of Suppliers
- 5.7.5. Industry Rivalry
- 5.8. Value Chain & Critical Path Analysis
- 5.9. Regulatory Framework
- 5.10. Client Customization
- 6. Healthcare Payer Services Market, by Outsourcing Service Type
- 6.1. Introduction
- 6.2. Business Process Outsourcing (BPO)
- 6.3. Information Technology Outsourcing (ITO)
- 6.4. Knowledge Process Outsourcing (KPO)
- 7. Healthcare Payer Services Market, by Application
- 7.1. Introduction
- 7.2. Analytics & Fraud Management
- 7.3. Billing & Accounts Management
- 7.4. Claims Management
- 7.5. HR Services Management
- 7.6. Integrated Front Office Service & Back Office Operations Member Management
- 7.7. Provider Network Management
- 8. Healthcare Payer Services Market, by End User
- 8.1. Introduction
- 8.2. Private Payers
- 8.3. Public Payers
- 9. Americas Healthcare Payer Services Market
- 9.1. Introduction
- 9.2. Argentina
- 9.3. Brazil
- 9.4. Canada
- 9.5. Mexico
- 9.6. United States
- 10. Asia-Pacific Healthcare Payer Services Market
- 10.1. Introduction
- 10.2. Australia
- 10.3. China
- 10.4. India
- 10.5. Indonesia
- 10.6. Japan
- 10.7. Malaysia
- 10.8. Philippines
- 10.9. Singapore
- 10.10. South Korea
- 10.11. Taiwan
- 10.12. Thailand
- 10.13. Vietnam
- 11. Europe, Middle East & Africa Healthcare Payer Services Market
- 11.1. Introduction
- 11.2. Denmark
- 11.3. Egypt
- 11.4. Finland
- 11.5. France
- 11.6. Germany
- 11.7. Israel
- 11.8. Italy
- 11.9. Netherlands
- 11.10. Nigeria
- 11.11. Norway
- 11.12. Poland
- 11.13. Qatar
- 11.14. Russia
- 11.15. Saudi Arabia
- 11.16. South Africa
- 11.17. Spain
- 11.18. Sweden
- 11.19. Switzerland
- 11.20. Turkey
- 11.21. United Arab Emirates
- 11.22. United Kingdom
- 12. Competitive Landscape
- 12.1. FPNV Positioning Matrix
- 12.2. Market Share Analysis, By Key Player
- 12.3. Competitive Scenario Analysis, By Key Player
- 12.3.1. Merger & Acquisition
- 12.3.1.1. Amazon closes USD 3.9 bn acquisition of healthcare provider One Medical
- 12.3.1.2. Prime Health Services Announces Acquisition of InterGroup Services Provider Network
- 12.3.1.3. Zelis to Acquire Healthcare Cost Control Innovator Payer Compass; Combined Assets to Deliver Advanced Claims Management Solutions
- 12.3.2. Agreement, Collaboration, & Partnership
- 12.3.2.1. Cognizant and Microsoft join hands to bring cloud-based tech solutions to healthcare
- 12.3.2.2. Humana Announces Agreement to Acquire remaining 60 Percent Interest in Kindred at Home, Accelerating Integration of the Nation’s Largest Home Health Provider into Humana’s Payer-Agnostic Healthcare Services Platform
- 12.3.3. New Product Launch & Enhancement
- 12.3.3.1. Innovaccer’s InNote Now Available to Payers to Improve Payer-Provider
- 12.3.3.2. Inovalon Adds All-Payer Claims Management Software to the PointClickCare Marketplace, Expanding Partnership
- 12.3.3.3. SBI General Insurance launches health vertical
- 12.3.4. Award, Recognition, & Expansion
- 12.3.4.1. Access Healthcare acquires a land parcel in Chennai
- 13. Competitive Portfolio
- 13.1. Key Company Profiles
- 13.1.1. AArete LLC
- 13.1.2. Accenture PLC
- 13.1.3. Acurus Solutions, Inc.
- 13.1.4. Anthem Insurance Companies, Inc.
- 13.1.5. athenahealth, Inc.
- 13.1.6. Atos SE
- 13.1.7. CitiusTech Inc.
- 13.1.8. Clarus RCM
- 13.1.9. Cognizant Technology Solutions
- 13.1.10. Concentrix Corporation
- 13.1.11. Conduent, Inc.
- 13.1.12. Connvertex Technologies Inc.
- 13.1.13. Dell, Inc.
- 13.1.14. ExlService Holdings, Inc.
- 13.1.15. Firstsource Solutions Limited
- 13.1.16. Genpact Limited
- 13.1.17. HCL Technologies Limited
- 13.1.18. Hewlett Packard Enterprise Company
- 13.1.19. Hexaware Technologies Limited
- 13.1.20. Hinduja Global Solutions Limited
- 13.1.21. Infosys Limited
- 13.1.22. International Business Machines Corporation
- 13.1.23. Invensis Technologies Pvt. Ltd.
- 13.1.24. IQVIA Inc.
- 13.1.25. Kiriworks, Inc.
- 13.1.26. McKinsey & Company
- 13.1.27. Mobisoft Infotech LLC
- 13.1.28. Mphasis
- 13.1.29. Newgen Software Technologies Limited
- 13.1.30. Nous Infosystems Pvt. Ltd.
- 13.1.31. NTT DATA Corporation
- 13.1.32. OSP
- 13.1.33. Pegasystems Inc.
- 13.1.34. PricewaterhouseCoopers LLP
- 13.1.35. Protiviti Inc.
- 13.1.36. R1 RCM Inc.
- 13.1.37. Ricoh USA, Inc.
- 13.1.38. ServiceNow, Inc.
- 13.1.39. System Soft Technologies LLC
- 13.1.40. TATA Consultancy Services Limited
- 13.1.41. Tech Mahindra Limited
- 13.1.42. Tegria Holdings LLC
- 13.1.43. Unimrkt Healthcare LLP
- 13.1.44. Unitedhealth Group
- 13.1.45. Vee Technologies
- 13.1.46. Viaante Business Solutions
- 13.1.47. VMware, Inc.
- 13.1.48. Wipro Limited
- 13.1.49. WNS (Holdings) Ltd.
- 13.1.50. Xerox Corporation
- 13.2. Key Product Portfolio
- 14. Appendix
- 14.1. Discussion Guide
- 14.2. License & Pricing
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